title: Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients.
abstract: BACKGROUND
  Aging and neurodegenerative disease predispose to delirium and are both associated with increased activity of the innate immune system resulting in an imbalance between pro- and anti-inflammatory mediators in the brain. We examined whether hip fracture patients who develop postoperative delirium have altered levels of inflammatory mediators in cerebrospinal fluid (CSF) prior to surgery.
  
  
  METHODS
  Patients were 75 years and older and admitted for surgical repair of an acute hip fracture. CSF samples were collected preoperatively. In an exploratory study, we measured 42 cytokines and chemokines by multiplex analysis. We compared CSF levels between patients with and without postoperative delirium and examined the association between CSF cytokine levels and delirium severity. Delirium was diagnosed with the Confusion Assessment Method; severity of delirium was measured with the Delirium Rating Scale Revised-98. Mann-Whitney U tests or Student t-tests were used for between-group comparisons and the Spearman correlation coefficient was used for correlation analyses.
  
  
  RESULTS
  Sixty-one patients were included, of whom 23 patients (37.7%) developed postsurgical delirium. Concentrations of Fms-like tyrosine kinase-3 (P=0.021), Interleukin-1 receptor antagonist (P=0.032) and Interleukin-6 (P=0.005) were significantly lower in patients who developed delirium postoperatively.
  
  
  CONCLUSIONS
  Our findings fit the hypothesis that delirium after surgery results from a dysfunctional neuroinflammatory response: stressing the role of reduced levels of anti-inflammatory mediators in this process.
  
  
  BACKGROUND
  The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient.
  
  
  BACKGROUND
  NCT00497978. Local ethical protocol number: NL16222.094.07.
authors.affiliation: Department of Neurology, Academic Medical Center/University of Amsterdam, PO box 22660, 1100 DD Amsterdam, the Netherlands. d.westhoff@amc.uva.nl.
authors.forename: Dunja
authors.initials: D
authors.lastname: Westhoff
authors.forename: Joost
authors.initials: J
authors.lastname: Witlox
authors.forename: Leo
authors.initials: L
authors.lastname: Koenderman
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Kalisvaart
authors.forename: Jos F M
authors.initials: JF
authors.lastname: de Jonghe
authors.forename: Mireille F M
authors.initials: MF
authors.lastname: van Stijn
authors.forename: Alexander P J
authors.initials: AP
authors.lastname: Houdijk
authors.forename: Inge C M
authors.initials: IC
authors.lastname: Hoogland
authors.forename: Alasdair M J
authors.initials: AM
authors.lastname: Maclullich
authors.forename: David J
authors.initials: DJ
authors.lastname: van Westerloo
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D016207:Cytokines / Q000134:cerebrospinal fluid*; D003693:Delirium / Q000134:cerebrospinal fluid*; D004311:Double-Blind Method; D005260:Female; D006620:Hip Fractures / Q000134:cerebrospinal fluid*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000134:cerebrospinal fluid*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines